ROI MEDIA LIMITED Order Hosting Packages Please use this form to order any of our standard monthly or prepaid hosting service packages. Items Schedule The Items Schedule forms part of and is to be read in conjunction with the Service Agreement (Terms & Conditions)Item 1 Full legal name of the business owner(s) and/or trustee(s)Business Type*Sole TraderPartnershipCorporationTrustLimited Liability PartnershipFull Legal Name of Business*Registration Number*Trading Name (if applicable)Address*We require the physical street address of the business. Mailing addresses are not acceptable. Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country - Please Select from the Menu Business Email* Business Telephone*Please include country and area codesItem 2 Nominated Contact This is the person within your business who will assume sole responsibility for communicating with us.Nominated Contact Name* First Name Last Item 3 The Work to be performed Work pursuant to the Monthly Service Packages or Prepaid Service Packages selected by the Client together with all other services deemed necessary by the Company to adequately perform the work.Item 4 The Fees The Monthly Fees for the Minimum Term pursuant to Paragraph 4.3 and/or the Prepaid Fees pursuant to Paragraph 4.4 of the Service Agreement (Terms & Conditions).Payment Options*I want to pay in twelve equal monthly installmentsI want to pre-pay now and save more than 15%Hosting Service Packages (Monthly)*Please select the Hosting Service Package you require. CLICK HERE to compare Hosting Service Packages. We will deduct 12 equivalent payments of the Total Payable from your nominated credit or debit card account.Standard Hosting Service Package - $29Premium Hosting Service Package - $49Platinum Hosting Service Package - $89Hosting Service Packages (Prepaid)*Please select the Hosting Service Package you require. CLICK HERE to compare Hosting Service Packages.Standard Hosting Service Package - $290Premium Hosting Service Package - $490Platinum Hosting Service Package - $890Declaration I/We the person(s) named in Item 1 confirm that the information provided by me/us to the Company is accurate and complete and hereby acknowledge having read the Service Agreement (Terms & Conditions) which together with this Items Schedule forms the entire basis of the agreement between me/us and the Company.Total Payable $0.00 Please enter your credit card details*Your credit card payment will be processed securely, via Stripe. We do not capture or retain your credit card details on this website. Card Details Cardholder Name Signature*When you click on AGREE & PAY NOW your payment will be processed by Stripe without leaving the page. It may take a minute or so to process the payment - so please be patient and just hang in there!NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.